Childhood Maltreatment in the Migraine Patient

  • Gretchen E. Tietjen
  • Dawn C. Buse
  • Stuart A. Collins
Headache (JR Couch, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Headache

Opinion statement

Maltreatment during childhood increases vulnerability to a host of health disorders, including migraine. Putative mechanisms linking maltreatment and migraine include stress-induced dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, as well as disruption of other stress-mediating homeostatic systems, including those involving endocannabinoids, monoamine neurotransmitters, oxytocin, and inflammation. Prolonged elevation of glucocorticoids alters the neural architecture of the limbic system, resulting in the structural as well as functional changes described in both maltreatment and in migraine. Although treatment trials for migraine have not stratified participants by abuse history, strategies, such as cognitive behavioral therapy, which alter stress responsivity, may be particularly effective in this subgroup. Some therapies involving the endocannabinoid, serotonergic, oxytonergic, and inflammatory systems are under investigation for migraine. Anti-epileptic drugs such as valproate and topiramate, which are FDA approved for migraine treatment, are also known to interfere with epigenetic changes induced by stress. Discerning the role for this mechanism in treatment of maltreated migraineurs may introduce another therapeutic avenue.


Childhood maltreatment Abuse Adverse childhood experiences Stress Migraine Genetics Epigenetics Inflammation Serotonin Oxytocin Hypothalamic–pituitary–adrenal axis Cognitive behavioral therapy 


Compliance with Ethical Standards

Conflict of Interest

Stuart A. Collins declares that he has no conflict of interest.

Gretchen E. Tietjen holds common stock in Johnson & Johnson and Stryker.

Dawn C. Buse is an advisory board member of Eli Lilly and has received research support from Allergan Pharmaceuticals, Dr. Reddy’s Pharmaceuticals, and Avanir Pharmaceuticals.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Gretchen E. Tietjen
    • 1
  • Dawn C. Buse
    • 2
    • 3
  • Stuart A. Collins
    • 1
  1. 1.Department of NeurologyUniversity of Toledo College of Medicine and Life SciencesToledoUSA
  2. 2.Albert Einstein College of MedicineBronxUSA
  3. 3.Montefiore Headache CenterBronxUSA

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